Can selective arterial clamping with fluorescence imaging preserve kidney function during robotic partial...

Area of Science:

• Urology
• Surgical Innovation
• Renal Function Preservation

Background:

• Robotic partial nephrectomy (RPN) is a standard treatment for kidney tumors.
• Preserving renal function is a key goal during partial nephrectomy.
• Near-infrared fluorescence (NIRF) imaging offers potential for enhanced surgical precision.

Purpose of the Study:

• To compare renal functional outcomes between RPN with selective arterial clamping guided by NIRF imaging and RPN without these techniques.
• To evaluate the impact of NIRF-guided selective clamping on postoperative kidney function.

Main Methods:

• A cohort of 42 patients underwent NIRF-enhanced RPN with selective clamping.
• Outcomes were compared to a matched cohort undergoing RPN without selective clamping and NIRF imaging.
• Matching criteria included tumor size, preoperative eGFR, and patient demographics.

Main Results:

• Selective clamping with NIRF demonstrated superior short-term renal function post-discharge (e.g., higher postoperative eGFR, smaller eGFR reduction).
• These functional benefits showed a trend towards attenuation at 3-month follow-up.
• The selective clamping group experienced a low rate of perioperative complications (Clavien grade I-III).

Conclusions:

• NIRF imaging-guided selective clamping in RPN is associated with improved short-term renal functional outcomes.
• The observed benefits diminished at later follow-up.
• Further randomized prospective studies are necessary to confirm long-term efficacy and kidney-specific outcomes.